How do I manage my uncontrollable T2D at 58?

Question

Hello doctor,

I am 58, and my type 2 diabetes has become completely uncontrolled over the past year despite being on maximum doses of multiple medications. My blood glucose readings are consistently above 350 mg/dL and sometimes spike over 500 after meals, even when I think I am following the diabetic diet correctly. I am on Metformin, long-acting insulin, and two other diabetes drugs, but my HbA1C is 12.1, which I know is dangerously high and life-threatening.

The constant hyperglycemia makes me feel exhausted, incredibly thirsty, and I am urinating every 30 minutes throughout the day and night, disrupting all normal activities. I am already developing serious complications, significant vision changes that make driving unsafe, numbness and burning pain in both feet, and slow-healing wounds that terrify me about amputations. My endocrinologist keeps increasing medication doses, but the side effects are becoming intolerable, including severe gastrointestinal problems and continued weight gain from insulin resistance.

I am scared about going blind, losing limbs, or dying from diabetic ketoacidosis, as my older sister did three years ago. Work is nearly impossible because I feel mentally confused and physically weak most days, and I may need to apply for disability. Are there any newer diabetes technologies, like insulin pumps or continuous glucose monitors, that might help someone with such poor control?

I am willing to try anything because I feel like this disease is winning and destroying my body rapidly.

Please help.

Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

I understand your concern.

Your sugars are really dangerously high, and with the symptoms you describe (constant thirst, very frequent urination, fatigue, weight gain, vision issues, neuropathy), you are heading towards a diabetic emergency if not stabilized soon. With HbA1C (glycated hemoglobin) above 12 and sugars hitting 500 after meals, the oral drugs have pretty much stopped working for you; this is what we call “glucotoxicity”. In such cases, we usually shift completely to an intensive insulin regimen, and sometimes even hospital admission for a few days is needed to stabilize sugars and break the cycle.

Yes, there are newer technologies that can help; insulin pumps (CSII - continuous subcutaneous insulin infusion) combined with a continuous glucose monitor (CGM) are actually a very good option for someone like you who is motivated and struggling despite maximal therapy. CGM will show you real-time sugars and trends, and pumps can deliver basal insulin and boluses accurately, way better than repeated injections sometimes.

But before jumping to pump therapy, you need urgent blood sugar control first, because with sugars this high, you are at risk of DKA (diabetic ketoacidosis) or hyperosmolar coma. Please discuss admission with your doctor right away or at least switch to a basal-bolus insulin regimen (four injections per day) under supervision.

The probable causes in your case are severe insulin resistance and pancreatic beta-cell burnout due to long-standing type 2 diabetes. Possible secondary causes like infection, stress, or steroid use are worsening sugars.

I suggest you undergo a few tests, such as:

HbA1c (already very high).
Fasting, postprandial sugars (continuous monitoring preferred).
Renal function.
Urine microalbumin.
Lipid profile.
Foot exam and eye exam (retinopathy check).
Screen for infections (urine and chest).

The probable diagnosis is severely uncontrolled type 2 diabetes with established complications (neuropathy and retinopathy). However, it could also be (differential diagnosis) uncontrolled type 2 diabetes, latent autoimmune diabetes in adults (LADA), sometimes mistaken for type 2, or a secondary diabetes due to drugs or hormonal disorders (rare).

I suggest you follow this treatment plan:

Immediate sugar control: Basal-bolus insulin regimen under doctor’s supervision or short hospital admission.
Switch to newer insulin analogs if possible.
Consider an insulin pump and CGM once sugars stabilize.
Painful neuropathy may need Pregabalin or Duloxetine.
A dietitian review for a strict but practical diabetic diet.
Weight management and supervised exercise (once sugars improve).

I suggest you follow a few preventive measures, such as:

Avoid missed doses, keep a sugar log.
Keep well hydrated.
Daily foot inspection.
Regular eye checkups every six to 12 months.

You need to follow up initially every one to two weeks till sugars stabilize, then monthly.

I hope my explanation was clear and helped ease your mind. If you ever have any questions, I am always here to help.

Thank you.